How to Prevent Diabetic Ketoacidosis

As described by MayoClinic.com, "diabetic ketoacidosis develops when you have too little insulin in your body. Without enough insulin, sugar (glucose) can't enter your cells for energy. Your blood sugar level rises, and your body begins to break down fat for energy. This produces toxic acids known as ketones. Left untreated, diabetic ketoacidosis may cause you to lose consciousness. Eventually, untreated diabetic ketoacidosis can be fatal."

My Experience with DKA and the Aftermath

I've been a diabetic some 10 years now and about four years ago, I had my first bout of diabetic ketoacidosis (also known as DKA). Once was bad enough, and you would think I'd have learned my lesson after that first episode, but I must not have taken it too seriously, or I wouldn't have landed back in ICU several months later fighting my second bout. Truth be told, I didn't take my illness seriously the first six years, so my suffering two episodes of DKA came as no surprise to anyone who knew me. In fact, I was spilling ketones for several years before it finally landed me in the hospital. Before I begin, let me just start off by explaining what diabetic ketoacidosis is.

As described by MayoClinic.com, "diabetic ketoacidosis develops when you have too little insulin in your body. Without enough insulin, sugar (glucose) can't enter your cells for energy. Your blood sugar level rises, and your body begins to break down fat for energy. This produces toxic acids known as ketones. Left untreated, diabetic ketoacidosis may cause you to lose consciousness. Eventually, untreated diabetic ketoacidosis can be fatal."

That said, I'd like to share with you my experience(s) with DKA in hopes it inspires diabetics to practice tight control so that this doesn't happen to anyone else, ever again.

I was diagnosed with type 1 diabetes at the age of 25. It came as a shock, because growing up, the worst thing I ever had was the flu, nothing so serious or complicated as an actual disease. (Then again, I wouldn't necessarily call diabetes a disease; rather a disorder. It's not like your body is being attacked by a foreign body; your pancreas simply stops producing insulin. And that, in my opinion, is a disorder, or a dysfunction of sorts, rather than a disease, but anyway...)

I must admit, my eating habits had been poor all my life. I had a serious sweet tooth and craved chocolate every day. Not only craved, but had chocolate, daily. And cookies, and ice cream, and soda, and danish, and chips, and...you get the picture. A day didn't go by that I wasn't eating something someone deemed I shouldn't, at least not in such vast quantities (and not just after a meal, but in place of each meal). Now that coupled with a family history of diabetes, heart disease and cancer, led to my diagnosis of type 1 diabetes at the age of 25. Normally, type 1 diabetes is a juvenile affliction; however, in my case, the doctors believed it was brought on by a viral infection that settled in my throat, that eventually triggered the onset of diabetes. It has been known to happen. And, sadly, it happened to me.

I had all the classic symptoms when I finally got up the nerve to see a doctor. Actually, my doctor was on vacation at the time, so I went to the emergency room when my symptoms started to really bug. When I walked in, initially the doctor took one look at me, and honest to God, practically spat in my face! He said something along the lines of, "You don't look sick. Now, get out of here and let me tend to the real patients! They actually need me. You don't!" Looking back now, I could have sued that bozo's pants off, the way he treated me! Even a hypochondriac "deserves" to get checked...just in case. I must say, I always looked younger than my years and when I was sick, it never showed. I had a healthy glow about me all my life, and even when I was stricken down with DKA, the paramedics took one look at me and said I looked too good to be sick! I suppose that's a compliment, but they seriously thought I was making it up and, at first, before they checked my pulse, weren't even considering taking me to the hospital! Goodness gracious, what's up with that?! At any rate...

I was able to convince the ER doctor who eventually ended up diagnosing me with type 1 diabetes to test my sugars, as I had a sneaky suspicion it was diabetes (family history, remember?), even if it did blow me away when he finally did admit I was very sick. I didn't want to believe it was happening to me. But, he did finally ask the nurse to check my sugars and my urine, and a few minutes later, he staggers back into the room, his red face turned stone white, and barely chokes out the words, "I'm very sorry, you looked so good, I couldn't believe when I saw the test results. You have diabetes, I suspect it's type 1, because you have ketones in your urine." My sugars were a mind-blowing 450, but what worried him the most were the ketones spilling into my urine. At the time, I didn't think too much of the ketones, not realizing they were far worse than the numbers, themselves, but six years later I finally came to understand why that ER doctor insisted I stay in the hospital at least overnight for observation. He said if I walk out the door, he would not be held responsible for whatever was to happen to me. I shrugged it off, as aside from the annoying symtoms of diabetes (dry mouth, blurry vision, fatigue, excessive thirst, frequent urination, the list goes on and on), I felt fine! It wasn't till six years later, it finally hit home.

I never really took my illness seriously, because like I said, aside from the usual symptoms, I felt fine, and didn't think it could get much worse. So, I learned to live with the fatigue, frequent urination, and excessive thirst, thinking that's just how it had to be from now on, dismissing the fact that these symptoms now were a sign of the complications that were to come later. It builds up, little by little, and much like a silent killer, it strikes suddenly, and when it finally does, it's too late to do much about it.

So, come mid-January six years later, I forget to take one insulin shot (that coupled with my bad eating habits) and wham! The nausea and vomiting hit me like a ton of bricks! This type of nausea does not let up, not for a second, and there's absolutely no relieving it, either. You would think that after throwing up all day I'd get some relief by nightfall, but the more I threw up, the worse I felt. Until, finally, near midnight, I couldn't stand it anymore, and decided to call 911. (At the time, I thought it was food poisoning; I never even heard of DKA. But, I had food poisoning once before, and it always made me feel better to throw up; this time, it was a lot worse.) By the time I got up to call 911, I must have been so badly dehydrated, that I could barely stand, I felt terribly light headed, and it was getting harder and harder to breath, my heart was racing and my face was flushed. The 911 operator asked me if anyone was with me, and I told him my mother, so he had the nerve to ask me why she didn't call 911 for me. What do you mean why? She was too busy panicking to help me, that's why!

The fire station is two blocks down from my house, so the paramedics got to my house in about a minute or so. But like I said, I was the picture of health even in my near-fatal condition, and they practically dismissed it, altogether! (No, I'm not overreacting, and no, I'm not an attention-you-know-what! If anything, I prefer to fade into the background, than make a scene.) Since the paramedics were already there, they checked my sugars -- 325 -- nothing unusual in a diabetic, and nothing to worry about, they say. Too bad they couldn't check my urine, because it was over flowing with ketones! And then they tell me to just take more insulin and drink some fluids, and assure me I'll feel better soon! With all my might I protested and begged them to take me to the ER. They oblige but don't realize the seriousness of my condition until they ask me to stand up and walk to the ambulance. I could hardly stand on my feet, my face went sheet white, and I started losing consciousness. I must have been one strong chicky in those days, because I felt I was going down, and forced myself to open my eyes. They checked my blood pressure where I was, in a standing position, and were surprised I was still conscious given my pulse was barely there! Disbelieving their eyes, they checked my pulse a few minutes later, and still, it was seriously low. At that time they got a stretcher, hoisted me up, and loaded me onto the ambulance and we sped away to the nearest hospital, which was only about a mile away.

I had a really good doctor in the ER, she made me feel better right away. I got a dose of anti-nausea meds, they put me on an insulin drip, and gave me an IV. I came back to early next morning, sat straight up and asked to be released. The doctor comes in with the diagnosis of DKA, and says I'm seriously ill. Then she says she'd like to check me in to the hospital upstairs and keep me there for observation. But, I protested. Eventually, she gave in. Fact of the matter is, I didn't have health insurance at the time, and couldn't afford to have my life saved any further. That night in the ER cost a whopping $12,000 -- I didn't want to know what a couple more days might cost in the hospital, so I all but yanked the IV out of my arm and called a taxi home.

Eight months later, I ended up in the same emergency room, with the same ER doctor. This time she wasn't so nice. She warned me to take better care of myself, but stupid me, I go back to my old eating habits, and wouldn't you know it, again, forget to give myself that one vital shot of insulin that day, and wind up in the very same ER, being seen by the very same doctor, only this time, I don't feel any better by morning, and agree to get checked in to the hospital, at whatever cost.

Four days and $35,000 later, I finally begin to understand the seriousness and severity of diabetes--not to mention what it can do to a body. I was in ICU for four days, my sugars, even on an insulin drip were holding strong at 400, but luckily the ketones cleared up the next day. You can battle high glucose, but you can't really fight ketones. They were worried about my heart; it was beating hard. My nausea wouldn't go away no matter what they pumped into me, and I kept vomiting the first couple days, so they were worried I'd become dehydrated. Astonishingly, my appetite was very good. So, that, they deemed, was a good sign.

When I started feeling better four days later, I asked to be released. They weren't ready to let me go, quite yet. But, I insisted, so they made me vow to go see a doctor the very next day, and start using three different types of insulin a day (before that I was only on one kind, which is why I got so sick in the first place). I promised to start taking better care of myself, and scheduled an appointment to see a doctor the next day right in front of the staff. Plus, before they checked me out, it was policy to speak with both a dietician and a social worker, which I did. The next morning, bright and early I'm checked out and finally go home.

Here's what you can expect after a serious episode of DKA:

When I got home, my nerves "went" completely. That's the first thing that diabetics lose, is tiny nerves that become depleted of necessary oxygen. Your eyes start going, your feet become numb (but not after they burn like the dickens for a good several years), your hair falls out, your nails become brittle, you get edgy over every little thing, your muscles twitch uncontrollably as if you had Parkinsons, but worst of all, your skin burns like a bad case of sunburn, and nothing can soothe it. If you see a dermatologist about it, he won't be of any help, as I saw one of the very best derms in Beverly Hills, and he charged me $250 to tell me he had no clue what I had. Don't bother going to see an endocrinologist, either, as I saw one who came highly recommended, again, his office was in Beverly Hills, and he said he's never heard of such a thing! I had some clue by then as to what was causing the burning sensation, so I asked him if it could just be my nerves dying, and he said that was impossible, as the burning sensation centered almost entirely around my chest and upper thighs. He also put me on an alarmingly high dose of insulin, which made my sugars drop severely, so I dropped him like a bad habit--what I should have done a long time ago to my poor eating habits.

Knowing full well in my heart it was my nerves, I consulted the doctor I saw when I was first diagnosed with diabetes, at the time, six years ago. I emailed her with my story and my symptoms before coming in so she could do some research on the matter, and lo and behold, she confirmed my suspicion with a diagnosis of paresthesia.

According to NIH.gov, "paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually...described as tingling or numbness, skin crawling, or itching." And in my case, severe burning!

The burning was so bad, that after a couple weeks of sheer agony, I asked the doctor to prescribe something, as regular over the counter pain killers were of little help. She put me on a drug called Lyrica. At the time, known side effects of Lyrica were swelling of the hands and possible weight gain, so I figured I'd give it a go. I figured I could deal with swollen hands a lot better than burning skin, so I started taking it, and felt better within a couple of days. Now, I won't go into too much detail about the drug, but you can read about it here, for yourself. The one thing I will say is, DO NOT TAKE IT! Avoid this drug like the plague, because I came to learn (the hard way) the seriousness and severity of Lyrica's side effects way before they were made known to the general public. Lyrica is a mind altering drug that's used for people with seizures, and some of its side effects include, but are not limited to, (and in my case), nausea, vomiting, fatigue, sleepiness, memory loss, confusion, deep depression and suicidal thoughts and tendencies. I was always an upbeat, happy person; always looking on the bright side, similing, loving life, until I started taking Lyrica for my paresthesia. Then suddenly, I became a whole different person. I was never in the mood to do anything, I was always weepy (though did my darndest to hide it), my nerves were always on edge, my body was under a heap of pressure, to the point I felt I had to punch a wall to relieve the tension, but the nausea and vomiting were the absolute worst physical symptoms. Not to mention, I was in a deep funk, terribly hopeless, depressed and almost always thought about how great it would be to just die already!

I contributed all this to Lyrica after about a year of suffering, yet at the same time, was scared out of my wits to go off of it, for fear the burning sensation would come back. My symptoms got so bad, that one night I thought I had gone back into DKA, because I started vomiting with no end in sight, and no relief to boot. Again, I called 911 and they rushed me to the nearest hospital, fearing the worst. The ER doctor came back with a diagnosis of...nothing. He said all my labs were fine. I then told him I was expecting my period the next day, and he attributed my nausea and vomiting to PMS. Then, I told him, "Doc, I didn't want to say anything, but I'm on Lyrica. Only, it's not what you think, I don't need it for depression (it's also used as an anti-depressant, but wouldn't that be defeating the purpose? It sure backfired in my case!); I have paresthesia." His eyes were big as saucers. That's what was causing it, the Lyrica, every month, like clockwork, just before my period and around ovulation, it was making me terribly sick, but over time, and with prolonged use, the symptoms become unbearable.

I went off Lyrica that day, and guess what? My skin didn't burn like it used to. These days, my upper thighs still burn a little just as the sun starts to set; it feels better when I apply a cool compress to the effected area, and give it a few hours. Kind of like how some people (myself, included) feel before a rain--their feet hurt. But, nothing so bad as before, and nothing close to the side effects of Lyrica!

It took about two whole years for those side effects to deminish after going off the drug. Hard to believe, but true. That's what happens when you take mind-altering meds, as I call them. They have a tendency to linger in your system, especially when you take them for a prolonged period of time. I'm wary of all meds now, and won't agree to take the usual hypertension meds and cholesterol meds diabetics normally take, thinking back on my horrible experience with Lyrica.

It's been four years since my first bout with DKA (at the time of this publication), and so far, so good. Though, I am taking better care of myself by watching what I eat, taking my insulin in time, not missing doses, and getting regular exercise, but the damage has been done. That initial bought of DKA got the ball rolling, and ever since, I've been gradually losing my eye sight, as well. Now, I suffer from something called diabetic retinopathy, not to mention peripheral neuropathy, but the nerves have died in my feet rendering them numb, and I'm losing sensation in my hands, as well.

So, exactly how does one prevent DKA?

Glad you asked. Let me tell you...

The one single most effective way to prevent DKA is by taking good care of your health from day one. And by day one, I don't mean day one of your diagnosis of diabetes; I'm referring to day one of your life. Don't take anything for granted, especially not your health. It's not guaranteed. Eat well, exercise, get enough sleep, and stress less--those are the four main ingredients for healthy living.

But, if you do have diabetes, as many of us do, then there's but one thing you can do to prevent DKA: Have tight control of your diabetes. Take your meds on time, the proper dosage, stay away from carbs aside from fresh fruit and vegetables, forget sweets altogether, avoid white flour, drink plenty of water, limit your caffiene intake, eat fresh foods, avoid eating out, avoid pre-packaged foods or frozen dinners (otherwise known as refined or manufactured products), and get enough exercise and restful sleep, and steer clear of people or things that can stress you out. Pretty simple, huh? Yeah, right! Since you don't have a choice in the matter, I suggest you do your very best, and hope it all works out. Also, before you start taking any medication, ask yourself if it's absolutely necessary, and weigh the pros and cons, and do some serious research, especially about the side effects.

Hopefully my experience is enough to get you going on your journey to better health!